Civil Liberties, Mental Health Care, and Public Policy

Reporter Pete Earley felt like he was standing “from the outside looking in” when he interviewed people for his crime articles and books. But when his son, Mike, went psychotic, Pete found himself on the inside looking out. Combining the perspectives of the distant reporter and an affected party, he recounts in Mad about her frustrating search for care for her son and also about the fate of prisoners suffering from mental illness.

Mike Earley suffered his first psychotic attack during his senior year at Brooklyn College. Over time he was diagnosed with bipolar disorder, schizophrenia, and schizoaffective disorder, each diagnosis brought with it different medications and different therapies. What a difference, Mike’s father points out, between accurate medical diagnosis and treatment of, say, a broken leg and impressionistic, trial-and-error labeling and treatment of mental illness.

Mike and his family found it difficult to access mental health care. “Listen,” a police officer told Pete, “even if your son broke into a house, unless you tell the medical staff inside that he threatened to kill you, they won’t treat him. We’ll end up taking him to jail.” , and you don’t want that to happen. You don’t want him in jail in his mental condition.”

Pete told lies to get treatment for his son, but even after hospital admission, Mike could not be medicated against his will. The attorney appointed to represent Mike at a commitment hearing told Pete that she would work to get Mike released from the hospital, psychotic or not, if he didn’t want to be there.

Mike’s charges in connection with the robbery threatened to ruin his life, but he was lucky and a felony was avoided. He eventually accepted medication, stabilized and found work. By the end of the book, Mike has re-entered the community as a productive young adult, albeit dependent on psychotropic medication. Still, as Pete makes clear, many mentally ill Americans who run afoul of the legal system fare much worse.

For his portrait of disturbed prisoners, Pete Earley went to Miami, Florida, and provided the historical background: the efforts of reformer Dorothea Dix, the rise of psychopharmacology in the 1950s, and the movement to do away with state mental hospitals in favor of of community mental health centers. starting in the early 1960s, from what he found there.

With deinstitutionalization, Earley reminds us, millions upon thousands of troubled people poured into the streets, where few resources awaited them. Community mental health centers were simply not equipped to treat the severely and chronically mentally ill. Over time, as their bizarre behaviors brought them into conflict with society at large, these disturbed people moved, not back into treatment centers, but into prisons and jails.

Some people, arrested for a minor crime, were detained for a few days and released only to be re-arrested and jailed. Others, charged with a felony, were sent to a hospital to be “competent” and sent back to prison, where they decomposed while awaiting trial until they had to be returned to the hospital. Even today, some prisoners spend years in this endless cycle without receiving adequate medical care.

Earley followed various inmates through the system, to the streets, and back to the prison. He also spoke with a court social worker and two experienced advocates. She learned of a pioneering facility that gives participants in her program a sense of community. She listened to family members describe the harrowing deaths of relatives who succumbed to drugs and crime when medical care proved inaccessible. And she reflected on the good fortune that had so far spared her son a similar fate.

Mad not only does it describe the ordeal of the distraught person and that of the family members who look on helplessly, but it also looks at the bigger picture. In doing so, he highlights questions about public policy and the priorities of contemporary American society at a critical moment in history.

• Where can a concerned parent access the treatment necessary to restore a child’s reason and thereby keep him and society safe?
• When someone has a chronic disease and cannot function, do we really want to give more importance to the right to liberty than to the right to health care?
• Does the risk of locking someone up unnecessarily or against their will inevitably outweigh the risk of an innocent person being killed or harmed for life by actions committed while out of control?

Which point of view should prevail over the many issues raised by Earley’s narrative? That of the sick and those who love him? That of the surrounding society, with its need for prescriptive laws to balance conflicting interests? Whichever path we take, we face fundamental questions about our national values. What basic rights should a citizen have? Who should decide?

As the disparity in this country grows between the few who have too much and the many who struggle to get by, we may well ask which should count more, the lofty ideals embodied in the Bill of Rights, with its elite 20th century sensibilities. XVIII. , or the essentials of life, including food, shelter, and health care, that all citizens need to survive. Mad is a valuable contribution to the ongoing debate.

Reviewed in this article: Pete Earley, Crazy: The Search for a Father Through America’s Mental Health Madness (New York: Putnam, 2005).